Gastrostomy buttons (“G-buttons”) are used by physicians in pediatric and adult patients with feeding/swallowing disorders. Patients with feeding difficulties are at risk for malnutrition, dehydration, and aspiration. Many patients are premature infants, infants with congenital heart disease, and young children who are neurologically impaired due to brain tumors, cerebral palsy, or traumatic brain injury. Children and adults receiving chemotherapy comprise another large subgroup of patients requiring nutritional support through supplemental feeding tubes such as a G-buttons. Many gastrostomy dependent patients are unable to communicate depending entirely on their health care providers to administer the appropriate formula/feeding regimen. Hospitalized patients often have their feeding regimens changed on a regular basis.
Most feeding tubes are placed endoscopically as percutaneous endoscopic gastrostomy (PEG) tubes. Gastrostomy tubes are typically replaced by G-buttons after 2-3 months' time. Patients and families prefer G-buttons to G tubes because G-buttons are small flat skin-level devices that are less obtrusive and more cosmetically appealing than G tubes. However, G-buttons still remain unsightly because of their unnatural appearance against a patient's abdominal skin. G-buttons are also preferred over G tubes because they easily connect/disconnect from extension tubing through which nourishment is provided. All G-buttons manufactured are presently non-decorative being made from clear or white plastics that are easily visualized against the patient's abdominal wall.
There are two types of gastrostomy buttons. The Bard® G-button shown in FIG. 1 has a mushroom-shaped dome that sits in the stomach lumen. The mushroom shape serves to anchor the tube in the stomach lumen and prevents the tube penetrating the abdominal wall from inadvertently slipping out of the abdomen. These buttons require a special stylet for placement and removal.
The Mic-Key® G-button manufactured by Kimberly-Clark Corp. shown in FIG. 2 has a water balloon in place of the mushroom shaped dome that is inflated/deflated for insertion and removal. All G-buttons incorporate a check valve assembly that allows liquid nourishment to flow into the patient's stomach, while preventing gastric contents from leaking outward. G-buttons are often placed on a semi-permanent basis; they must be changed out periodically as patients outgrow their button sizes. Balloons also deteriorate with time and pop requiring complete button replacement. Many patients will require a lifetime of supplemental G-button feedings.
There are a number of significant problems associated with G-button placement. Chief among these is the negative psychological association with placement of a permanent feeding tube. Placement of a G-button is a last resort, when all other therapies and techniques to provide nutritional support have failed. Thus, for the families of patients, placement of a G-button is often tantamount to admitting defeat. Placement of a G-button is commonly associated with a lack of progress with therapeutic interventions to improve oral feeding skills. For the patient and his/her family, placement of a permanent feeding tube therefore is symbolic of the patient's chronic underlying medical/neurological condition and confirms the permanence of the condition. Adults requiring permanent feeding tubes have similar negative psychological reactions to G-buttons for many of the same reasons. Adults, adolescents, and children are typically conscious of the unsightly appearance of an exposed G-button on the abdomen. Because of this, patients may delay placement of a G-button. This can result in further malnutrition, which ultimately exacerbates their underlying medical condition.